Today we welcome physical therapist Joshua K. Renzi, PT, MPT, COMT, FAAOMPT and co-owner of Spine & Sports Rehabilitation to our PT Profile series. Josh is a Member, American Physical Therapy Association (APTA) and American Academy of Orthopedic Manual Physical Therapists (AAOMPT). He focuses his clinical practice on osteopathic manual therapy and differential diagnosis and incorporates neuromuscular re-education as well as exercise prescription to form an individualized rehabilitation program for his patients. He enjoys problem solving “difficult cases,” especially when other treatment has failed.
Josh has been in practice in Baltimore since 1998 after earning his Master’s Degree in Physical Therapy from the University of Maryland, School of Medicine. He is a Certified Orthopaedic Manual Therapist and a Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT).
Josh serves as a consultant for local industry in the area of ergonomic modification and injury-prevention, and provides expert advice for local running groups and tri-athletes. He serves as a teaching assistant for the PTF Orthopaedic Residency Program and has guest lectured at University of Delaware Department of Physical Therapy.
Josh enjoys working with geriatric patients and athletes of all ages, especially those who share his interest in swimming, biking, running, golfing, weight lifting, and martial arts training. He is a competitive middle and long distance runner and tri-athlete. Let’s have a chat with him.
Where do you practice?
I am a co-owner of a small private practice, Spine and Sports Rehabilitation Center, in Timonium Maryland, which is 7 miles north of Baltimore City. We recently opened a small satellite clinic in Owings Mills Maryland, which is northwest of Baltimore. Including myself, we have six full time therapists on staff, most of whom are certified manual therapists.
Why did you choose PT as a career?
Physical therapy combined my two interests of physical activity and scientific study. While at Loyola University in Baltimore, I volunteered at a local hospital and worked in an outpatient clinic. These experiences confirmed my interest in physical therapy. During these experiences, I was fortunate to work with talented PTs whose love and drive for the study of physical therapy was contagious. They further inspired me to pursue PT as my career.
Is there a specific area of PT you’re particularly drawn to/enjoy doing?
I can’t imagine working in anything other than outpatient orthopedics as a manual therapist. Being able to take a patient through a treatment of a variety of manual therapy and neuromuscular re-ed techniques, and have them feel instantly better, is addictive. Even after 17 years in the clinic I still love seeing that moment of relief/disbelief (although I try it play it cool) on a patient’s face when they are able to move easier or with less pain. This is an even more rewarding experience when the patient has been through physical therapy elsewhere and didn’t respond to treatment. What I like most about outpatient orthopedics, is the ability to utilize problem solving skills in a clinical setting.
Tell us about a PT-related challenge you’ve faced so far and how you worked through it.
When a patient doesn’t improve as much as expected, it is frustrating for any physical therapist. Underlying anatomical or systemic issues can pose uncontrollable challenges for therapists, but it still bothers me when we fall short of our goals. To deal with these challenges, it is important to be able to step back and look at the problem with fresh eyes. I am fortunate to have a talented group of PTs in my practice. Our collaboration on difficult cases is important both for finding new approaches to treatment, but also for expanding our clinic’s knowledge of patient’s presentation and co-morbidities. I’m proud that in my office, egos are put aside in the interest of patient treatment. Having a strong staff, as well as access to excellent mentorship, has been a huge asset for me as a mentee in my Fellowship program, but also as a mentor to my colleagues.
Do you participate in PT continuing education and/or learning new manual therapy techniques?Why or why not?
Most definitely. Obviously continuing education is an essential part of every clinician’s viability. However, I think it is more important to identify the right kind of continuing education course. This starts with identifying reputable continuing education institutions who use sound scientific principles as well as teach cutting edge techniques. I am biased toward manual therapy and neuro re-ed that challenge what I know, or think I know. I believe that a good clinician will seek out difficult and challenging courses that work to broaden their clinical perspective. It’s like playing tennis with someone who is better than you, it makes you a better player, and keeps you humble.
What role do you think mentorship plays in the PT field?
Mentorship has been an invaluable learning tool for me. Sharing in-clinic treatments with a master clinician offers a wider perspective on patient problems, and deepens your own reflection on treatment strategies. Mentorship allows latitude for incorporating different treatment strategies over the course of several sessions. Having to explain, and at times defend, treatments helped me learn a great deal about how I analyze a patient’s problem. It was also a great opportunity to learn new techniques, some of them made up (ahem, Terry Pratt!), that will stay in by treatment arsenal forever.
Is there a recent study or article that somehow influenced you or your approach to PT?
Most of the things that I have read over the past few years have been written by the faculty of NAIOMT. Articles written by Erl Pettman and Cliff Fowler have tied much of what is taught in the NAIOMT courses with what I have experienced in the clinic. These articles reinforced the concepts of deductive reasoning, differential diagnosis and the integration of the mechanics of the entire body and how they relate to particular pathologies. Every PT program teaches, and most PTs know, to look to the joint above and below the pathology, however, that falls way too short for a clinician who is interested in more than treating the pain.
Also, one of my mentors turned me on to the book “Clinical Reasoning for Manual Therapists” by Jones and Rivett. This book offers clinical reasoning insight on case presentations authored by well-known physical therapists. I have found it interesting and refreshing to compare how some of the world’s best clinicians utilize the philosophies and techniques that they are known for, as well as how they incorporate other treatment strategies.
What are some of the changes you hope can be made within PT in the next decade?
I hope to see more physicians recognize the skills that physical therapist have, and that our relationship continues to move toward a collegial one. Many doctors that we work with at Spine and Sports Rehabilitation know that our clinical approach to patient care is broader than most clinics. It still surprises me, however, how many physicians continue to be unaware the skills that PTs have when it comes to differential diagnostics and the value that manual therapy and neuro re-ed can have for their patient’s outcome. The key to changing their perceptions of us is to improve patient outcomes by providing the level of care of which we are capable.
What steps do you think PTs can be doing now to get closer to those changes?
Stop doing lame treatments! Our best marketing comes down to providing a more comprehensive approach to treatment and then having the patients share their experience with their physicians. Outstanding patient care is the best way to convince physicians and the community of the benefits of physical therapy. Use of modalities and lame exercises will not get us there.
What is it that makes you a PT worth seeing?
In my practice, I draw from a variety of schools of thought and incorporate many of them into every treatment. By being able to change the schema through which I view a patient’s problem list, I am able to change strategies fairly fluidly when I am not getting the results I expect. Usually this means meshing together a variety of treatment strategies within the same treatment. I think that many PTs are unable to “step back” and look at a patient’s dysfunction from a different perspective. In order to reduce my own bias, I routinely step back and try to see what I am not seeing, as well as employ the support of my team of therapists. The patients that I see who have previously been to multiple therapists appreciate my willingness to take the time to look at them as a whole as well as my willingness to take the time to explain to them how different seemingly unrelated joint or muscle limitations fit together with their chief complaint. Then I try to do something about it!
Follow Josh on Twitter as well as his clinic Spine & Sports Rehabilitation.
And see full list of upcoming NAIOMT manual therapy continuing education opportunities here.